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El-Naggar W, Almudeer A, Vincer M, Yanchar NL. Preoperative metabolic acidosis in infants with gastroschisis. J Neonatal Perinatal Med 2018; 10:307-311. [PMID: 28854513 DOI: 10.3233/npm-16128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There is little in literature regarding preoperative management of infants with gastroschisis. It is unclear if these infants develop metabolic acidosis as a consequence of prolonged intrauterine gut compromise or dehydration secondary to increased fluid loss. AIM To assess the frequency of preoperative metabolic acidosis in infants with gastroschisis and investigate whether this acidosis reflects degree of gut compromise. METHODS All infants with gastroschisis born between May 2005 and April 2013 in a single tertiary care center were reviewed. Metabolic acidosis was defined by the presence of pH <7.26 and serum bicarbonate <18.5 or base excess < -8.5 mmol/l. Infants with significant birth depression were excluded. Maternal and neonatal data were collected. Frequency of preoperative metabolic acidosis and its association with gastroschisis prognostic score (GPS), time to first and time to reach full feeds were investigated. RESULTS Sixty infants were identified, 11 were excluded (birth depression/lack of preoperative blood gases). Median preoperative total fluid intake was 130 ml/kg/d. Nine infants (18%) had metabolic acidosis at a median age of 1.2 hours. No association was found between metabolic acidosis or serum lactate and GPS, age at first feed or age at full feeds. CONCLUSION Preoperative metabolic acidosis was identified in a significant number of patients with gastroschisis despite high fluid intake. It does not appear to be associated with the degree of gut compromise. Using metabolic acidosis as an indication of dehydration in these patients needs more investigation.
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Affiliation(s)
- W El-Naggar
- Department of Pediatrics, Division of Neonatal Perinatal Medicine, Dalhousie University, Halifax, NS, Canada
| | - A Almudeer
- Department of Pediatrics, Division of Neonatal Perinatal Medicine, Dalhousie University, Halifax, NS, Canada
| | - M Vincer
- Department of Pediatrics, Division of Neonatal Perinatal Medicine, Dalhousie University, Halifax, NS, Canada
| | - N L Yanchar
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
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Clive B, Corsten G, Penney LS, Van den Hof M, El-Naggar W. Severe laryngeal stenosis in newly born twins with 22q11.2 deletion syndrome: A case report. J Neonatal Perinatal Med 2017; 9:223-6. [PMID: 27197926 DOI: 10.3233/npm-16915068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chromosome 22q11.2 deletion syndrome is common and presents with a range of clinical features from cardiac malformations to hypocalcemia. Laryngeal anomalies are not a common feature of this syndrome. We describe newly born twins who presented with unexpected severe birth depression secondary to severe type IV glottic webs requiring extensive resuscitation and emergency tracheostomy. They were diagnosed postnatally to have deletion of 22q11.2. The successful resuscitation of these infants at birth was only possible because they were born in a tertiary care hospital. This report shows the critical nature of prenatal diagnosis of 22q11.2 deletion syndrome.
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Affiliation(s)
- B Clive
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - G Corsten
- Department of Pediatric Otolaryngology, Dalhousie University, Halifax, Canada
| | - L S Penney
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - M Van den Hof
- Department of Obstetrics & Gynecology, Dalhousie University, Halifax, Canada
| | - W El-Naggar
- Department of Pediatrics, Dalhousie University, Halifax, Canada
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El-Naggar W, Simpson D, Hussain A, Armson A, Dodds L, Warren A, Whyte R, McMillan D. The Effect of Umbilical Cord Milking on Hemodynamic Status of Preterm Infants: A Randomized Controlled Trial. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Delayed cord clamping may be difficult to perform in extremely preterm infants. The effects of the alternative, cord milking, have not been fully evaluated.
OBJECTIVES: To determine whether cord milking (CM) at birth improves systemic blood flow and short term outcomes, as compared with immediate cord clamping (ICC).
DESIGN/METHODS: Babies born to eligible, consenting women presenting in preterm labor between 24 and 31 weeks' gestation were randomized to receive CM or ICC. Echocardiography was performed at 4-6 and 10-12 hours after birth. The primary outcome was systemic blood flow as represented by echo-derived superior vena cava (SVC) flow. Neonatal care staff, echogardiographer and interpreter were blind to the randomization. Analysis was by intention to treat.
RESULTS: A total of 73 eligible infants were randomized (37 to CM and 36 to ICC) during the study period (November 2011-2014). There were no statistically significant differences in maternal demographic and antenatal variables. Mean (SD) gestational age was 26.1 (11) weeks and mean (SD) birth weight was 1025 (308) g. 38% of infants were born by vaginal delivery. No significant differences were found between groups in SVC flow, cardiac outputs or neonatal morbidities [table1].
CONCLUSION: There were no statistically significant differences in functional cardiac outcomes, mortality or morbidity between preterm infants who received CM and those who received ICC. Larger trials are needed to establish the best practice in managing the umbilical cord at birth in extremely preterm infants.
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Afifi J, Vincer M, Shah V, Ye XY, Shah PS, Barrington K, Kelly E, Piedboeuf B, El-Naggar W. Can We Predict Post-Hemorrhagic Ventricular Dilatation in Preterm Infants with Severe Intraventricular Hemorrhage? Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e51a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: The incidence of post-hemorrhagic ventricular dilatation (PHVD) remains high in preterm infants. Little is known about the risk factors for PHVD in infants with severe intraventricular hemorrhage (IVH).
OBJECTIVES: To determine the predictors of PHVD among preterm infants with severe IVH.
DESIGN/METHODS: We conducted a retrospective review of all pre-term infants (22+0 - 32+6 weeks) who were admitted to NICUs participating in the Canadian Neonatal Network between 2010 and 2014. Infants with severe IVH (IVH with ventricular dilatation or parenchymal bleeding) who survived ≥ 72 hours were included. Perinatal and neonatal risk factors were compared between infants with and without PHVD (lateral ventricles >10 mm).
RESULTS: Of 16600 eligible infants, 1964 (11.8%) developed severe IVH. Of 1815 infants with severe IVH who survived ≥72 hours, 616 (34%) developed PHVD. Factors associated with occurrence of PHVD include: lower gestational age, small for gestational age, low 5 minute Apgar score, SNAPII score>20, surfactant therapy, high frequency oscillatory ventilation (HFOV), inotropes and occurrence of pneumothorax. [table 1]. There were no differences between both groups in relation to antenatal steroids, multiple pregnancy, mode of delivery, birth weight, gender or the proportion received prophylactic indomethacin. Multivariate analysis showed low five-minute Apgar score and HFOV to be independent predictors of PHVD while maternal magnesium sulfate and small for gestation (SGA) to be protective against PHVD.[table 2].
CONCLUSION: Our study identified factors involved in the prediction of PHVD in a national cohort of preterm infants. The mechanisms by which these factors may impact PHVD need further investigation.
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Afifi J, Vincer M, Shah V, Ye X, Shah P, Barrington K, Piedboeuf B, Kelly E, El-Naggar W. Epidemiology of Posthemorrhagic Ventricular Dilatation in Canadian Neonatal Intensive Care Units. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Severe intraventricular hemorrhage (IVH) is a common cause of neonatal morbidity and mortality .The incidence and management of post-hemorrhagic ventricular dilatation (PHVD) vary among different centres.
OBJECTIVES: To assess the incidence, temporal trend, management and associated outcomes of PHVD in Canadian NICUs.
DESIGN/METHODS: We conducted a retrospective review of all pre-term infants (22+0 -32+6 weeks) who were admitted to NICUs participating in the Canadian Neonatal Network between 2010 and 2014. Infants with severe IVH (IVH with ventricular dilatation or parenchymal bleeding) who survived ≥ 72 hours were included. We compared the rates of severe IVH, PHVD and VP shunting between the 5 Canadian regions. Short-term outcomes of infants who developed PHVD (ventricles size ≥10 mm) were compared with those who did not.
RESULTS: Of 16600 eligible infants, 1964 (11.8%) developed severe IVH. Of 1815 infants with severe IVH who survived ≥72 hours, 616 (34%) developed PHVD and 91 (5%) treated with VP shunt. No significant difference in the incidence of severe IVH, PHVD or VP shunting over the last five years was noted. There was a statistically significant difference in the rates of severe IVH (p<0.0001) and PHVD (p=0.02) among the 5 Canadian regions. VP shunts rates were variable with some Canadian regions with higher rates of PHVD had low rates of VP shunts. [figure 1]. Infants with PHVD had significantly higher mortality and short term morbidities. [table 1]. On regression analysis, PHVD is an independent predictor of death in infants with severe IVH [adjusted OR 1.55, 95% CI (1.18, 2.04)]. Infants with VP shunt had significantly higher rates of severe ROP (p<0.0001), meningitis (p<0.0001), and hospitalization (89 vs 41 days, p<0.0001).
CONCLUSION: PHVD is an independent predictor of death and is associated with adverse short- term outcomes. Variability exists between different regions in managing PHVD. Further studies are needed to investigate the impact of this variability on long-term outcomes.
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Clive B, Vincer M, Ahmad T, Khan N, Kuhle S, Afifi J, El-Naggar W. Epidemiology of Neonatal Stroke: A Population-Based Study. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Neonatal stroke (NS) is a known cause of cerebral palsy, epilepsy and cognitive deficits in up to 50% of patients. Understanding its epidemiology can help in early identification of affected patients and in improving outcomes.
OBJECTIVES: To obtain population-based data on the incidence, clinical presentation, treatment, imaging features and outcomes of patients with all types of neonatal stroke.
DESIGN/METHODS: Full term neonates born to mothers living in Nova Scotia between 2007 and 2013 and diagnosed with NS were identified through the province’s Perinatal Follow-up Program Database. Neonates with significant congenital anomalies or hypoxic ischemic encephalopathy were excluded. Perinatal data and neonatal course were reviewed. Neurodevelopmental outcomes were assessed at 18 months of age using the standardized cognitive adaptive test/clinical linguistic auditory milestone scale (CAT/CLAMS).
RESULTS: Twenty-nine neonates (47 per 100,000 live births) with NS were identified during the study period. The mean gestational age was 39±1 weeks and mean birth weight was 3278±579 g. In twenty-two (76%), NS was due to neonatal arterial ischemic stroke (NAIS), 2 (7%) to cerebral sinovenous thrombosis, and 5 (17%) to intracerebral hemorrhage. Seizures were the most common presenting sign. [table] The median length of stay in hospital was 7 days (4-21). At 18 months of age, only 2 patients (7%) were found to have cerebral palsy and one had epilepsy (3%). CONCLUSION: The majority of patients with NS had NAIS and presented with seizures on the first day of life. The incidence of NS in Nova Scotia is higher than reported in the literature, however the neurodevelop-mental outcomes are better.
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Shah V, Shah P, Kelly E, Mukerji A, Afifi J, El-Naggar W, Vincer M. Neurodevelopmental Outcomes in Preterm Infants with Intraventricular Hemorrhage in Canada. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e50a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Conflicting evidence exists in regards to outcomes of infants with mild IVH [subependymal hemorrhage (SEH) and IVH without ventricular dilatation (VD)] with recent reports suggesting poor outcomes.
OBJECTIVES: To compare 1) neurodevelopmental (ND) outcomes of infants < 29 wks GA with normal head ultrasound scan findings (Group 1: no IVH/PVL/VD to those with a) Group 2: SEH or IVH without VD, b) Group 3: IVH with VD (ventricle size > 10 mm) and c) Group 4: persistent intraparenchymal echogenicity (IPE) or lucency with or without IVH and 2) composite outcome of death or ND impairment (NDI)/severe NDI (SNDI) at 18-24 months in these groups.
DESIGN/METHODS: Retrospective cohort study of data from Canadian Neonatal Network (CNN)and Canadian Neonatal Follow-up Network (CNFUN) from April 2010 to September 2011. NDI was defined as any one of Bayley III score < 85 (cognition, language or motor), cerebral palsy (CP) or visual/hearing impairment. SNDI was defined as Bayley III score < 70 for any of the 3 components, CP with GMFCS > 3, severe visual impairment <20/200 or hearing impairment needing aids/cochlear implants. Data for the 4 groups were compared using Chi-squared test or ANOVA as appropriate. Multivariable regression was conducted to obtain adusted OR (95% CI).
RESULTS: See tables on page e51.
CONCLUSION: In this large national cohort, infants with SEH and/or IVH without VD had similar outcomes to infants with no IVH. The risk of death or adverse ND outcome was significantly higher ininfants with IVH with VD and those with IPE.
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Akinloye OW, Truong W, Giacomantonio M, Mateos D, El-Naggar W. Coexistence of meconium ileus with duodenal atresia and trisomy 21 in a newborn: a case report. J Perinatol 2014; 34:875-6. [PMID: 25359414 DOI: 10.1038/jp.2014.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 11/09/2022]
Abstract
The coexistence of duodenal atresia (DA) may mask the antenatal ultrasound findings of meconium ileus (MI) and delay its postnatal diagnosis. We report a rare case of MI in a newborn infant diagnosed antenatally to have trisomy 21 and DA. The diagnosis of MI was only established intraoperatively after the patient showed persistent signs of intestinal obstruction following the surgical repair of the DA.
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Affiliation(s)
- O W Akinloye
- IWK Health Centre, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - W Truong
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - M Giacomantonio
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - D Mateos
- Department of Respirology, Dalhousie University, Halifax, NS, Canada
| | - W El-Naggar
- IWK Health Centre, Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
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El-Naggar W, Almudeer A, Vincer M, Yanchar N. 83: Preoperative Metabolic Acidosis in Infants with Gastroschisis. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Akinloye O, El-Naggar W, O’Connell C, Allen A. The Need for Post-Resuscitation Care in Infants ≥35Weeks’ Gestation who Receive Positive Pressure Ventilation (PPV) at Birth. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.37ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hassan R, El-Naggar W, Habib E. Comparative Studies on Staphylococcus Aureus Isolates Associated with Infections in Diabetic and Non-Diabetic Patients. ACTA ACUST UNITED AC 2012. [DOI: 10.12816/0004882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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El-Naggar W, Ibrahim R, Habib E, Gerorge S, Abd-Elmagid E. A Comparative study on gram-negative bacterial infections in Mansoura University Hospitals, Egypt. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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El-Naggar W, Yiu A, Mohamed A, Shah V, Manley J, McNamara P, Taddio A. Comparison of Infant Pain Responses Between two Different Methods of Urine Collection for Diagnosis of Infection: Suprapubic Aspiration and Urinary Catheterization. Paediatr Child Health 2009. [DOI: 10.1093/pch/14.suppl_a.48aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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